scholarly journals Usefulness of Ultrasound Imaging in Detecting Psoriatic Arthritis of Fingers and Toes in Patients with Psoriasis

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Clara De simone ◽  
Giacomo Caldarola ◽  
Magda D'Agostino ◽  
Angelo Carbone ◽  
Cristina Guerriero ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Joint Space ◽  
New Bone Formation ◽  
Chronic Plaque Psoriasis ◽  
X Ray ◽  
Dermatology Clinic ◽  
Soft Tissue Swelling ◽  
Psa Progression

Background. Given that clinical evaluation may underestimate the joint damage and that early treatment can slow down psoriatic arthritis (PsA) progression, screening psoriasis patients with imaging tools that can depict early PsA changes would entail clear benefits.Objective. To compare the ability of X-ray and ultrasound (US) examination in detecting morphological abnormalities consistent with early PsA in patients with psoriasis, using rheumatological evaluation as the gold standard for diagnosis.Methods. Patients with chronic plaque psoriasis and no previous PsA diagnosis attending our outpatient dermatology clinic and reporting finger/toe joint and/or tendon pain underwent X-ray and US evaluation; they were subsequently referred to a rheumatologist for clinical examination and review of imaging findings.Results. Abnormal US and/or X-ray findings involving at least one finger and/or toe (joints and/or tendons) were seen in 36/52 patients: 11 had one or more X-ray abnormalities, including erosion, joint space narrowing, new bone formation, periarticular soft tissue swelling, and periarticular osteoporosis; 36 had suspicious changes on US.Conclusion. US proved valuable in detecting joint and/or tendon abnormalities in the fingers and toes of patients with suspicious changes. The dermatologist should consider US to obtain an accurate assessment of suspicious findings.

scholarly journals Hand Full of Sausages-Forme Frustae of Severe Psoriatic Arthritis: A Case Report

2021 ◽  
Author(s):  
A Ramesh ◽  
C Vijayabhasar ◽  
Rajkumar Kannan ◽  
Samuel Jeyaraj Daniel ◽  
P Deepavarshini
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Psoriasis Vulgaris ◽  
Joint Space ◽  
Initial Symptom ◽  
C Reactive Protein ◽  
X Ray ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Soft Tissue Swelling

Dactylitis or sausage shaped digits is one of the hallmark features of psoriatic arthritis which occurs in association with psoriasis. This is a report of 50-year-old female, known case of psoriasis vulgaris, presented with complaints of red, painful and swollen digits of both hands since two weeks. She also complained of pain and restricted movements of all small joints of hands since two days. On examination, all the digits were erythematous, tender and swollen. Investigations revealed elevated Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP), negative rheumatoid factor and x-ray hands showed joint space narrowing and soft tissue swelling. Based on Classification Criteria for Psoriatic Arthritis (CASPAR) with score of 3/6, psoriatic arthritis was diagnosed. Further evaluation of other joints revealed features of sacroiliitis in x-ray pelvis. Psoriatic dactylitis involving all digits and as an initial symptom of psoriatic arthritis is rarely reported in literature. Dactylitis involving all the digits may be a forerunner of severe psoriatic arthritis.

scholarly journals Novel Composite Radiographic Score for Longitudinal Observational Studies of Psoriatic Arthritis: A Proof-of-concept Study

2016 ◽  
Vol 43 (2) ◽  
pp. 367-370 ◽  
Author(s):  
William Tillett ◽  
Gavin Shaddick ◽  
Deepak Jadon ◽  
Graham Robinson ◽  
Eleanor Korendowych ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Observational Studies ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Proof Of Concept ◽  
X Ray ◽  
Radiographic Score ◽  
Hands And Feet ◽  
Longitudinal Observational Studies ◽  
Data Reductions

Objective.To devise a feasible composite radiographic score for use in observational studies of psoriatic arthritis (PsA).Methods.Radiographs from 50 patients with PsA were evaluated with the PsA-modified Sharp, Sharp/van der Heijde (SvdH), and Ratingen scores. Data reductions were made to devise a concise score.Results.The Reductive X-ray Score for Psoriatic Arthritis (ReXSPA) required the assessment of only 22 joints (234 points), including erosion, joint space narrowing, and osteoproliferation in the hands and feet. The ReXSPA accounted for 80% of change detected with the SvdH score.Conclusion.We report a proof-of-concept radiographic score for observational studies derived though data reduction.

Repair of Radiographic Joint Damage Following Treatment with Etanercept in Psoriatic Arthritis Is Demonstrable by 3 Radiographic Methods

2011 ◽  
Vol 38 (6) ◽  
pp. 1066-1070 ◽  
Author(s):  
LIHI EDER ◽  
VINOD CHANDRAN ◽  
DAFNA D. GLADMAN
Keyword(s):  
Psoriatic Arthritis ◽  
Scoring System ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Joint Space ◽  
Radiographic Assessment ◽  
Radiographic Damage ◽  
Erosion Score ◽  
Sharp Score ◽  
Hands And Feet

Objective.Psoriatic arthritis (PsA) is characterized by varied radiographic features. We describe a patient with PsA with severe radiographic damage that improved significantly following treatment with etanercept. The improvement was documented by several methods of radiographic assessment.Methods.Etanercept was introduced in September 2005. Radiographs of the hands and feet were read using 3 methods: the modified Steinbrocker method, the van der Heijde (vdH) modification of the Sharp method, and the Ratingen scoring system.Results.In July 2009, radiographs of the hands and feet showed improvement in erosion score and joint space narrowing, while bony proliferation remained the same [43 by modified Steinbrocker, 26 by the vdH Sharp score (12 for erosions and 14 for joint space narrowing), and 56 by the Ratingen (18 for erosion and 38 for proliferation].Conclusion.The 3 radiographic methods were useful in demonstrating improvement in joint scores. The modified Steinbrocker method, which is the simplest, was able to reveal improvement in our patient.

Film-Screen Vs. Digital Radiography in Rheumatoid Arthritis of the Hand

1994 ◽  
Vol 35 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Á. Jónsson ◽  
A. Borg ◽  
P. Hannesson ◽  
K. Herrlin ◽  
K. Jonsson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Soft Tissue ◽  
Digital Radiography ◽  
Joint Space Narrowing ◽  
Digital Images ◽  
Roc Curves ◽  
Joint Space ◽  
Hard Copy ◽  
Significant Difference ◽  
Soft Tissue Swelling

In a prospective investigation the diagnostic accuracy of film-screen and digital radiography in rheumatoid arthritis of hands was compared. Seventy hands of 36 patients with established rheumatoid arthritis were included in the study. Each of 11 joints in every hand was evaluated regarding the following radiologic parameters: soft tissue swelling, joint space narrowing, erosions and periarticular osteopenia. The digital images were obtained with storage phosphor image plates and evaluated in 2 forms; as digital hard-copy on film and on a monitor of an interactive workstation. The digital images had a resolution of either 3.33 or 5.0 lp/mm. ROC curves were constructed and comparing the area under the curves no significant difference was found between the 3 different imaging forms in either resolution group for soft tissue swelling, joint space narrowing and erosions. The film-screen image evaluation of periarticular osteopenia was significantly better than the digital hard-copy one in the 3.33 lp/mm resolution group, but no significant difference was found in the 5.0 lp/mm group. These results support the view that currently available digital systems are capable of adequate diagnostic performance.

Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis

2021 ◽  
pp. annrheumdis-2020-218744
Author(s):  
Irina Gessl ◽  
Mihaela Popescu ◽  
Victoria Schimpl ◽  
Gabriela Supp ◽  
Thomas Deimel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Power Doppler ◽  
Joint Damage ◽  
Joint Space ◽  
Early Arthritis ◽  
Damage Score ◽  
Established Disease ◽  
Active Inflammation

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).ConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

Psoriatic Nail Dystrophy Is Associated with Erosive Disease in the Distal Interphalangeal Joints in Psoriatic Arthritis: A Retrospective Cohort Study

2019 ◽  
Vol 46 (9) ◽  
pp. 1097-1102 ◽  
Author(s):  
Anna S. Antony ◽  
Andrew Allard ◽  
Adwaye Rambojun ◽  
Christopher R. Lovell ◽  
Gavin Shaddick ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Joint Disease ◽  
Nail Dystrophy ◽  
Chi Square ◽  
Convenience Sample ◽  
Radiographic Damage ◽  
Erosive Disease ◽  
Distal Interphalangeal

Objective.To assess whether the association between psoriatic nail dystrophy and radiographic damage in the hands of patients with psoriatic arthritis (PsA) is specific to the distal interphalangeal (DIP) joints.Methods.A convenience sample of patients was collated from the Bath longitudinal PsA cohort. All patients had PsA according to the ClASsification for Psoriatic ARthritis criteria (CASPAR) criteria, scored radiographs of their hands, and documented nail scores as measured by the Psoriatic Nail Severity Score. Chi-square tests were performed to examine for association between features of nail dystrophy and radiographic damage in the DIP joints, and proximal interphalangeal or metacarpophalangeal (non-DIP) joints of the corresponding digits.Results.There were 134 patients included, with a median age of 53 years (interquartile range; IQR 44–61) and disease duration of 7 years (IQR 3–17). The presence of any form of psoriatic nail dystrophy was associated with erosion at the DIP joints of the corresponding digit (OR 1.9, 95% CI 1.23–2.83; p < 0.004) and this association was primarily driven by the presence of nail onycholysis (OR 1.72; 95% CI 1.12–2.62; p = 0.02). Nail subungual hyperkeratosis was more strongly associated with joint space narrowing, erosions, and osteoproliferation at the corresponding DIP joint compared to non-DIP joints (p < 0.001). Nail pitting was not associated with erosions or osteoproliferation.Conclusion.The presence of psoriatic nail dystrophy, particularly onycholysis, is associated with erosive disease at the DIP joints. Subungual hyperkeratosis is more strongly associated with erosive damage at the DIP than non-DIP joints. These findings support the anatomical and pathological link between nail and DIP joint disease.

Rheumatoid Hand and Other Hand-deforming Rheumatic Conditions

2021 ◽  
Vol 25 (02) ◽  
pp. 232-245
Author(s):  
Iwona Sudoł-Szopińska ◽  
James Teh ◽  
Anne Cotten
Keyword(s):  
Bone Marrow Edema ◽  
Joint Space Narrowing ◽  
Soft Tissues ◽  
Connective Tissue Diseases ◽  
Joint Space ◽  
Imaging Features ◽  
Resonance Imaging ◽  
Soft Tissue Swelling ◽  
Rheumatic Conditions ◽  
Magnetic Resonance Imaging Mri

AbstractThe hand and wrist are commonly involved in rheumatic conditions, particularly rheumatoid arthritis and other systemic connective tissue diseases. With spondyloarthritis, hand and wrist involvement frequently occurs in psoriatic arthritis but generally does not occur in the remaining subtypes. The hand and wrist may also be affected in various metabolic and endocrine diseases, but these lie beyond the scope of this review.Radiographs may demonstrate the presence of joint space narrowing, bone loss, cysts and erosions, malalignments, and osteolysis. They may also show regions of soft tissue swelling or thinning, and detect calcifications. Ultrasonography and magnetic resonance imaging (MRI) enable evaluation of the soft tissues, particularly the synovium, tenosynovium, and tendons. Furthermore, erosions are better demonstrated than on radiographs. MRI allows evaluation of periarticular bone marrow edema.This article discusses typical imaging features of the hand and wrist in rheumatologic conditions including the advantages and limitations of the various methods.

Serum Cartilage Oligometric Matrix Protein and Pettersson Scoring System As an Index for Hemophilic Arthropathy

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2855-2855
Author(s):  
Hoda MA Hassab ◽  
Wessam M EL-Gendy ◽  
Khaled I M El-Noueam ◽  
Hayam M Abdel Ghany ◽  
Myssoon M Elwan
Keyword(s):  
Serum Level ◽  
Cartilage Oligomeric Matrix Protein ◽  
Matrix Protein ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Joint Space ◽  
Functional Independence ◽  
Control Group ◽  
Hemophilic Arthropathy ◽  
Group I

Abstract The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage, and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (hemophilic synovitis) that contributes to end stage degeneration (hemophilic arthropathy); with pain and limitation of motion that severely affects patients’ quality of life. The aim of the present study was to evaluate the degree of joint damage in boys with hemophilia using plain x-ray, and to measure serum level of human cartilage oligomeric matrix protein, to determine its relation to the degree of joint damage. The study was carried out on thirty boys with hemophilic arthropathy (group I) and ten healthy boys were included as control (group II). All hemophilic patients were scored for Functional independence score (FISH score) in hemophilia and radiological changes (Pettersson’s score) using conventional frontal and lateral radiographs of the most affected joint. Factor activity level was measured for all hemophilic patients while serum cartilage oligomeric matrix protein (COMP) was measured for hemophilic patients and control group. Among the thirty hemophilic patients, 26 (86.7%) patients were hemophilia A and 4 (13.3%) patients were hemophilia B All patients were receiving on demand replacement therapy using plasma derived Factor concentrate or fresh frozen plasma (FFP) according to availability. Fifteen patients (50%) had severe hemophilia, 7 (23.3%) had moderate and 8(26.72%) had mild hemophilia. A higher serum level of COMP with a mean of 757± 211.30 in the severe hemophiliacs, and a mean of 403.57 ± 86.49 and 211.25 ± 74.26 in the moderate and mild hemophiliacs respectively the difference was statistically significant (p < 0.001). Serum level of COMP in group I was significantly higher than in group II (p=0.004) with significant negative correlation with FISH score (r=-0.435 p=0.016). COMP correlated positively with joint space narrowing of the Pettersson score (r=0.421 p<0.001) and with total Pettersson score (r=0.421 p=0.020). The number of joints affected (during life) of hemophilic patients ranged between 1-12 with a mean of 5.50 ± 2.46 Joints. A significant positive correlation between serum level of COMP and number of joints affected (r = 0.487, p = 0.006). Joint space narrowing is the most important indicator of cartilage loss. Serum COMP level is indicative of the amount of joint damage in patients with hemophilic arthropathy. The combined scoring of functional independence and Pettersson in addition with serum levels of COMP give a good overview of the degree of hemophilic arthropathy Disclosures No relevant conflicts of interest to declare.

scholarly journals Validity and Responsiveness of Combined Inflammation and Combined Joint Damage Scores Based on the OMERACT Rheumatoid Arthritis MRI Scoring System (RAMRIS)

2019 ◽  
Vol 46 (9) ◽  
pp. 1222-1227 ◽  
Author(s):  
Ulf Sundin ◽  
Mikkel Østergaard ◽  
Daniel Glinatsi ◽  
Anna-Birgitte Aga ◽  
Kim Hørslev-Petersen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Scoring System ◽  
Bone Marrow Edema ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Patient Characteristics ◽  
Joint Space ◽  
Damage Score ◽  
Derivation Cohort ◽  
Magnetic Resonance Imaging Mri

Objective.The RAMRIS [Outcome Measures in Rheumatology rheumatoid arthritis (RA) magnetic resonance imaging (MRI) Scoring system] is used in clinical RA trials. We have investigated methods to combine the RAMRIS features into valid and responsive scores for inflammation and joint damage.Methods.We used data from 3 large randomized early RA trials to assess 5 methods to develop a combined score for inflammation based on RAMRIS bone marrow edema, synovitis, and tenosynovitis scores, and a combined joint damage score based on erosions and joint space narrowing. Methods included unweighted summation, normalized summation, and 3 different variants of weighted summation of the RAMRIS features. We used a derivation cohort to calculate summation weights to maximize the responsiveness of the combined score. Construct validity of the combined scores was examined by assessing correlations to imaging, clinical, and biochemical measures. Responsiveness was tested by calculating the standardized response mean (SRM) and the relative efficiency of each score in a validation cohort.Results.Patient characteristics, as well as baseline and followup RAMRIS scores, were comparable between cohorts. All combined scores were significantly correlated to other imaging, clinical, and biochemical measures. Inflammation scores combined by normalized and weighted summation had significantly higher responsiveness in comparison to unweighted summation, with SRM (95% CI) for unweighted summation 0.62 (0.51–0.73), normalized summation 0.73 (0.63–0.83), and weighted summation 0.74 (0.64–0.84). For the damage score, there was a trend toward higher responsiveness for weighted summation.Conclusion.Combined MRI scores calculated by normalized or weighted summation of individual MRI pathologies were valid and responsive.

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